ETHICAL ISSUES AND THE BREAST-CANCER PATIENT

The association of cancer and death in laypeoples' thinking has result ed in discussions of cancer diagnoses often being held sub rosa. Open acceptance of a diagnosis of canter cannot only help to dispel associa ted fears but also can serve to educate other persons to recognize tha t cancers can be cured, Open discussion of diagnoses of breast cancer by well-known public figures increasingly has focused media attention on related issues. Numerous ethical issues applicable to breast cancer (and to other chronic and/or canter diagnoses) include: informed cons ent; education of relatives, friends, and public; patients' comfort in discussion of their diagnoses and treatment; access to care; and allo cation of scarce resources. Genuine informed consent involves discussi ons of all relevant medical issues with the patient so that she unders tands the ramifications of the diagnoses, treatment, risks, and benefi ts of undergoing or of refusing treatment; acid enables the patient to make a reasoned autonomous decision. Sufficient time must be allowed for development of this understanding because all persons, but especia lly apprehensive patients, tend to be selective in their hearing of ex planations: to hear what they are afraid to hear, what they want to he ar, and what they ape prepared to hear. Limitations of funding for hea lth care raise further questions about access to needed treatment. The concerns of the NIH Office of Research on Women's Health and of the W omen's Health Initiative include breast dancer, as do those of the pop ulace at large.